[Successful Early Surgical Treatment for Infected Traumatic Pulmonary Pseudocyst].

Almost all traumatic pulmonary pseudocysts (TPP), such as cavitary pulmonary lesions after blunt chest trauma, resolve spontaneously. On the contrary, secondary infection of a TPP should be considered in the presence of purulent sputum or hemosputum and a persistent cavity. We report a case of an infected TPP that was successfully treated by early surgical treatment. A 25-year-old man was transferred to our hospital with a TPP, shown by computed tomography (CT) as having a thick-walled large cavity, after the acute phase of blunt chest trauma. Purulent hemosputum suggested infection of the cavity. Serial CT scans of the chest revealed a persistent cavity. The thick-walled large cavity was diagnosed as a secondary infection of the TPP, that is, a potential lung abscess. We resected the cavity before a systemic inflammatory reaction occurred.

[CLINICAL INVESTIGATION OF 6 CASES OF TUBERCULOUS SPONDYLITIS].

[Objective] A delay in the diagnosis of tubercu- lous spondylitis can result in worsening of the condition. We investigated previously reported cases of tuberculous spondylitis, as well as cases experienced in our hospital, to identify factors that are useful in the diagnosis. [Materials and Methods] We retrospectively evaluated six cases of tuberculous spondylitis diagnosed in our hospital between October 2007 and September 2012, and an additional 23 cases that had been reported in Japan between 1994 and 2014. [Results] The median age of our six patients was 78.5 years and five were women. In all cases, the focal lesion was seen in 2-3 adjacent vertebrae; four patients had miliary tuberculosis and five had lower back pain. All patients received oral treatment for 10-12 months. Among the 23 patients previously reported, 57% were women, and a focal lesion was found in 2-3 adjacent vertebrae in 86%. In addition, 57% had miliary tuberculosis and 65% had lower back pain. A personal and family history of tuberculosis was found in 20% and 26%. [Discussion] Radiographic assessment and microbiological testing of areas other than the chest and spine are useful in the diagnosis of tuberculous spondylitis. Furthermore, lower back pain, lower extremity symptoms, and personal and family history of tuberculosis are important factors. [Conclusion] When tuberculous spondylitis is suspected, diagnosis may be possible by investigating focal lesions in areas other than the spine.

Malignant amelanotic melanoma of the pleura without primary skin lesion:an autopsy case report.

Melanoma metastasizing to the lungs is common, but primary pulmonary or pleural melanoma is extremely rare. We present an autopsy case of malignant melanoma of the pleura without primary skin lesion in a 49-year-old man. A mass found in the right chest was diagnosed as spindle cell sarcoma by antemortem fine-needle aspiration cytology. At autopsy, a yellow-white tumor located primarily in the right visceral pleura (diagnosed as an amelanotic melanoma) was found to have invaded into the right lung, right parietal pleura, and right diaphragm, and to have metastasized into the left lung and visceral pleura, thyroid, and left adrenal gland. No primary site was found. The tumor cells were positive for S100 and focally positive for HMB-45, but negative for other markers. Immuno-histochemical examination for S100 and HMB-45 would thus appear to be useful for the diagnosis of an amelanotic melanoma.

Mucinous adenocarcinoma of the thymus: a case report.

A mucinous adenocarcinoma of the thymus is rare, and there is presently limited information on the clinical aspects of this uncommon type of tumor. Only six cases have been reported in the literature. A 49-year-old Japanese male presented with an anterior mediastinal mass, and underwent a tumor resection. Histologically the tumor consisted of a mucinous adenocarcinoma with pleural dissemination. Postoperative radiotherapy and chemotherapy were performed. The patient is still alive with pleural dissemination 11 months after surgery.

[Trends in drug-resistant tuberculosis in National Higashisaitama Hospital, 1994-2001].

To know the prevalence of resistance to four first-line anti-tuberculosis drugs, we reviewed the results of drug-susceptibility tests of patients with tuberculosis who were admitted to our hospital from 1994 to 2001. Among patients with no prior chemotherapy against tuberculosis, the complete resistance rate was 1.9% for INH, 0.81% for RFP, 5.1% for SM, 0.81% for EB, and 0.32% for multiple drug-resistance (MDR). The acquired resistance rate was 9.7% for INH, 11.5% for RFP, 7.3% for SM, 2.4% for EB, and 6.1% for MDR. There was no significant increase in the prevalence of drug resistance between the first half (1994-1997) and the latter half (1998-2001) of the investigation periods. Compared with the previous reports, our results indicated no increase in the prevalence of drug resistance in tuberculosis patients with no prior treatment and the decrease of prevalence in patients with prior treatment of tuberculosis. A multi-drug regimen consisted of INH, RFP, PZA and EB or SM, which is currently considered as a standard regimen of tuberculosis chemotherapy and used quite widely, does not seem to induce the increase of drug-resistant tuberculosis.

[Superior sensitivity of MGIT method in identification of specimens culture-positive for acid-fast bacilli (AFB) and individuals with positive AFB cultures].

To investigate the superiority of the Mycobacteria Growth Indicator Tube (MGIT) over Ogawa medium in the detection of acid-fast bacilli (AFB), we surveyed all specimens for AFB culture using Ogawa medium in 1999 and MGIT in 2000. The MGIT method increased the culture-positive rate from 23.1% (Ogawa medium) to 34.5% (p < 0.01). The culture-positive rate in smear-negative specimens was greatly increased (from 9.5% to 16.9%) (p < 0.01). The culture-negative rate in smear-positive specimens was decreased to 19.5% from 27.7% (p < 0.01). More individuals with positive M. tuberculosis cultures were found by the MGIT method than with Ogawa medium. Many more individuals with nontuberculous mycobacteria (NTM), notably those with NTM other than M. avium complex, were detected by the MGIT method than with Ogawa medium. The use of the MGIT method in the clinical laboratory will improve sensitivity in the detection of AFB.